A nurse in the emergency department (ED) is triaging four clients following a mass casualty event. The nurse should identify which of the following clients as emergent?
A client who has a leg and ankle fracture
A client who reports flank pain radiating to the groin
A client who has a raised red rash on the abdomen
A client who has expiratory stridor
The Correct Answer is D
A. A leg and ankle fracture is serious but typically not life-threatening compared to issues involving airway obstruction or severe bleeding.
B. Flank pain radiating to the groin may indicate a kidney stone or other condition, but it is less urgent than airway obstruction.
C. A raised red rash on the abdomen could be a sign of a less urgent condition, such as a viral infection or allergic reaction, and does not require immediate intervention compared to respiratory distress.
D. Expiratory stridor indicates upper airway obstruction or severe respiratory distress, which is a life-threatening condition requiring immediate intervention. Stridor suggests possible airway compromise, which needs to be addressed urgently to prevent respiratory failure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Darkening the room can help reduce light sensitivity, but it does not address the underlying cause of the headache.
B. Increasing fluid intake is effective in managing a headache after a lumbar puncture because it helps replenish cerebrospinal fluid (CSF) and reduces the risk of post-lumbar puncture headache, which often results from CSF leakage.
C. Naproxen sodium can provide relief for headache pain, but increasing fluid intake addresses the root cause of the headache more directly.
D. Elevating the head of the bed is generally recommended for certain conditions, but it is not the most effective strategy for addressing a post-lumbar puncture headache, which is better managed by increasing fluid intake.
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}
Explanation
Sepsis: The client's low CD4 count indicates a weakened immune system, making them susceptible to infections. The presence of fever, cough, and other symptoms suggests a potential infection, which can lead to sepsis if not treated promptly.
Malnutrition: The client's weight loss, diarrhea, anorexia, and difficulty eating are all signs of malnutrition. A compromised immune system can also contribute to malnutrition.
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